During the coronavirus disease 2019 (COVID-19) pandemic, burnout has become prevalent among gastroenterologists in Southeast Asia, driven strongly by fears of getting infected and the stress of reduced income, according to a Singapore study presented at the recently concluded Asian Pacific Digestive Week 2021 (APDW 2021).

“The COVID-19 pandemic has placed significant stress on gastroenterologists worldwide. However, its toll on the mental health of gastroenterologists within Southeast Asia was unknown,” said Josh Ong, from the Department of Medicine at the National University of Singapore, lead author of the study. “This was a multinational study to establish the prevalence of burnout and its risk factors within the region.”

Through the local gastroenterology and endoscopy societies, the researchers disseminated online surveys to 1,761 gastroenterologists across Brunei, Indonesia, Singapore, Malaysia, Thailand, and the Philippines from 1 September to 7 December 2020. The survey featured the extensively validated 22-item Maslach Burnout Inventory.

Overall, 38.8 percent returned survey responses, of whom 66 showed significant stress caused by the pandemic. The regional prevalence of burnout was 17.10 percent, though wide inter-country variation was observed. [APDW 2021, abstract OPP-0010]

For instance, burnout occurred most frequently in Malaysia (35.10 percent), followed by Brunei (33.30 percent) and Singapore (30.30 percent). On the other hand, such prevalence was relatively lower in Thailand (20.50 percent), the Philippines (11.90 percent), and Indonesia (5.20 percent).

To determine the correlates of burnout and assess the magnitude of their impact on risk, the researchers conducted logistic regression and content analyses to synthesize quantitative and qualitative data, respectively.

They found that additional stress at work caused by the pandemic was the strongest risk factor for burnout, increasing its likelihood by over four times (odds ratio [OR], 4.41, 95 percent confidence interval [CI], 2.01–9.69; p<0.01). A similar but weaker effect was reported for depression diagnosed before or during the pandemic (OR, 3.37, 95 percent CI, 1.21–9.36; p=0.02).

Being a trainee (vs consultant: OR, 2.37, 95 percent CI, 1.14–4.92; p=0.02), working in the public sector (OR, 2.58, 95 percent CI, 1.08–6.18; p=0.034), and the lack of awareness regarding mental health support services (OR, 1.83, 95 percent CI, 1.05–3.18; p=0.032) were all also significant risk factors for burnout.

Common stressors included service requirements (53.2 percent), the fear of getting infected (39.7 percent), reduced income due to the pandemic (28.0 percent), difficult relationships with parents or relatives (23.0 percent) or with colleagues (20.5 percent), and increased workload due to strict infection control measures (18.5 percent).

Notably, 50.1 percent of the respondents said that they were either unaware or did not have access to mental health support services.

“Burnout is indeed common in gastroenterologists in Southeast Asia during the COVID-19 era, and better safeguards for mental health are urgently needed,” Ong said.